《黃帝內經素問補註釋文》Vol. 30

Supplementary Notes and Annotations on the Basic Questions of the Inner Classic of the Yellow Emperor, Scroll Thirty

Commentary by Wang Bing, known as Qixuanzi, Director of the Court of Imperial Sacrifices during the Tang dynasty.

Revised and collated by Lin Yi and others, Palace Attendant of Splendid Happiness and Director of the Secret Archives during the Song dynasty.

Further corrections to errors by Sun Zhao, Gentleman of the Ministry of Works, during the Song dynasty.

“On the Proper Depth of Acupuncture”

The Yellow Emperor asked, “I would like to understand the differences in the depths of acupuncture.”

This concerns the respective levels of the skin, flesh, sinews, vessels, and bones.

Qibo replied, “When needling the bones, do not injure the sinews. When needling the sinews, do not injure the flesh. When needling the flesh, do not injure the vessels. When needling the vessels, do not injure the skin. When needling the skin, do not injure the flesh. When needling the flesh, do not injure the sinews. When needling the sinews, do not injure the bones.”

The Yellow Emperor said, “I still do not understand what this means. Please explain.”

Qibo said, “To needle the bones without injuring the sinews means that when the needle reaches the level of the sinews, it is withdrawn rather than inserted farther toward the bones. To needle the sinews without injuring the flesh means that when the needle reaches the level of the flesh, it is withdrawn rather than inserted farther toward the sinews. To needle the flesh without injuring the vessels means that when the needle reaches the level of the vessels, it is withdrawn rather than inserted farther toward the flesh. To needle the vessels without injuring the skin means that when the needle reaches the level of the skin, it is withdrawn rather than inserted farther toward the vessels. These methods are all intended to dispel pathogenic influences. If cold pathogen is in the sinews, wind pathogen in the flesh, damp pathogen in the vessels, or heat pathogen in the skin, needle at the corresponding level to drive it out. Here, ‘pathogen’ refers to anything that departs from the healthy Qi and assails the body.”

Editorial note: This passage says that needling should be shallower and should not reach the level that would ordinarily be needled; the passage below warns against needling too deeply.

“To needle the skin without injuring the flesh means that when the illness is in the skin, the needle should enter the skin without harming the muscles. To needle the flesh without injuring the sinews means that the needle passes through the muscles without harming the sinews. To needle the sinews without injuring the bones means that the needle passes through the sinews without harming the bones. This method is called ‘reversal.’”

This warns against letting the needle pass beyond the proper level and penetrating too deeply.

Editorial note: According to Quan Yuanqi, needling in this way causes injury. Excessive needling inevitably depletes the body’s blood and Qi. This is called violating the proper way, and it also gives pathogenic influences an opportunity to enter.

“On Prohibitions in Acupuncture”

The Yellow Emperor asked, “I would like to understand the prohibitions in acupuncture.”

Qibo replied, “Each of the body’s internal organs has vital points and vulnerable areas. These must be carefully understood. The liver arises on the left—”

The liver belongs to Wood and flourishes in spring. In spring, Yang Qi begins to rise, so it is said that the liver arises on the left.

“The lungs are stored on the right—”

The lungs belong to Metal and flourish in autumn. In autumn, Yin Qi gathers and brings a killing chill, so it is said that the lungs are stored on the right.

Editorial note: According to Yang Shangshan, the liver belongs to Lesser Yang, whose Yang Qi gradually increases…

Thus, the lung belongs to Lesser Yin. It is the first of the Yin organs, which is why it is called a “storehouse.”

The heart governs the body’s exterior. Yang Qi governs the outside, and the heart’s nature is like fire; therefore, the heart is said to govern the exterior.

The kidneys govern the body’s interior. Yin Qi governs the inside, and the kidneys’ nature is like water; therefore, the kidneys are said to govern the interior.

[Textual note] The New Textual Corrections says that Yang Shangshan regarded the heart as the ruler of the Five Organs, which is why it is called the “department.” The moving Qi between the kidneys governs the interior of the Five Organs, which is why it is called “governance.”

The spleen is called the “envoy.” Nutritive Qi circulates without pause, driving the distribution of the refined substances from food and drink and enabling waste to be expelled; therefore, the spleen is called the “envoy.”

The stomach is called the “market.” Food and drink all gather in the stomach, and the five flavors all enter it. Like a marketplace where many goods come together, it is called the “market.”

Above the diaphragm and the membrane, at the center, are a person’s “parents.” Above the diaphragm and the membrane, the Sea of Qi lies at the center. Qi is the foundation of life, and life arises from it; therefore, the Sea of Qi is called a person’s parents.

[Textual note] The New Textual Corrections quotes Yang Shangshan: The membrane lies below the heart and above the diaphragm. The heart is Yang and resembles the father; the lung is Yin and resembles the mother. The lung governs Qi, and the heart governs blood. Together, they cause Nutritive Qi and Defensive Qi to circulate throughout the body, which is why they are called the parents.

Beside the seventh vertebra is the “ Lesser Heart.” Here, “Lesser Heart” refers to the place where the true heart and the spirit reside.

[Textual note] The New Textual Corrections says that the Taishu reads “Heart of Intent.” Yang Shangshan held that the spine has twenty-one vertebrae, and that the kidneys lie beside the seventh vertebra counted upward from the bottom. The kidney spirit is called “Intent.” Each of the Five Organs has its own spirit, and the heart spirit may also be called “Intent.”

Following these principles brings good fortune; going against them brings calamity. To “follow” means to act in accordance with them. The eight points described above are the foundations on which the human body is generated and its form takes shape. Follow them, and blessings will continue; go against them, and calamity will come.

If acupuncture mistakenly strikes the heart channel, the person will die within a day. At the onset of the illness, belching occurs. Belching is the heart’s expression in the movement of Qi.

If acupuncture mistakenly strikes the liver channel, the person will die within five days. At the onset of the illness, speech becomes abnormal. “Speaking” is the liver’s expression in the movement of Qi.

[Textual note] The New Textual Corrections says that both the Quan Yuanqi edition and the Jia Yi Jing read “yawning.” Quan Yuanqi believed this resulted from injury to the kidneys, since the kidneys and liver have a parent-child relationship and illness can affect one another. Wang Bing changed “yawning” to “speaking.”

If acupuncture mistakenly strikes the kidney channel, the person will die within six days. At the onset of the illness, sneezing occurs. Sneezing is the kidneys’ expression in the movement of Qi.

[Textual note] The New Textual Corrections says that both the Quan Yuanqi edition and the Jia Yi Jing read “three days.”

If acupuncture mistakenly strikes the lung channel, the person will die within three days. At the onset of the illness, coughing occurs. Coughing is the lung’s expression in the movement of Qi.

If acupuncture mistakenly strikes the spleen channel, the person will die within ten days. At the onset of the illness, swallowing occurs.

The Spleen’s expression of Qi is “swallowing.” Textual note: The New Corrected Edition says that, according to the Quan Yuanqi recension and the Jia Yi Jing, this passage should read “fifteen days,” not “ten days.” The related passages in “Needling the Vital Points of the Five Zang Organs” overlap with those in “The Essentials of Diagnosis and the Endings of the Channels” and “The Four Seasons: Needling in Accord with or Against the Flow.” This section follows the generating sequence of the Five Zang organs. The Jia Yi Jing, by contrast, follows their controlling sequence, in the order Heart, Lung, Liver, Spleen, and Kidney. The old text in the Quan Yuanqi recension is jumbled and lacks coherence.

If the vital point on the Gallbladder channel is struck, the patient will die after a day and a half. The reaction that follows is vomiting. The Gallbladder’s Qi is fierce and forceful, which is why vomiting occurs. Textual note: The New Corrected Edition says that “The Essentials of Diagnosis and the Endings of the Channels” adds, after “striking the Gallbladder,” that striking the diaphragm injures the internal organs. Even if the condition improves, the patient will not live beyond a year.

If the large pulse on the dorsum of the foot is struck and the bleeding does not stop, the patient will die.

“Dorsum” refers to the top of the foot. The “large pulse” means the pulsating point of the Stomach channel. If it is struck and bleeding does not stop, the Stomach is the sea of water and grain—that is, the main organ that receives and holds food and drink. Heavy, persistent blood loss weakens Stomach Qi, as though the sea had dried up and the breath been spent; death follows.

If the liu vessel on the face is injured, the patient may become blind.

The liu vessel on the face is where the Hand Taiyang channel meets the Ren Mai. The Hand Taiyang channel runs diagonally from the cheekbone to the inner canthus. The Ren Mai rises from beside the nostrils to beneath the pupils. Thus, striking the liu vessel on the face may cause blindness.

If the Brain Gate point on the head is struck and the needle penetrates the brain, death will be immediate.

Brain Gate is the name of an acupuncture point above the occipital bone, connected to the brain. The brain is the sea of marrow and the place where primordial Qi gathers. If a needle enters the brain, primordial Qi will disperse, causing immediate death.

If the vessels beneath the tongue are needled too deeply and the bleeding does not stop, the patient will lose their voice.

The vessels beneath the tongue belong to the Spleen channel. The Spleen channel runs alongside the throat, connects with the root of the tongue, and spreads beneath the tongue. If bleeding does not stop, Spleen Qi can no longer be properly distributed to the tongue, and the ability to speak is lost.

If the collateral vessels spread across the sole of the foot are needled, and a channel vessel is struck without bleeding, swelling will occur.

“Spread-out collaterals” refers to the collateral vessels distributed in the hollow of the sole, in front of the inner ankle, roughly around the Rangu point. If a collateral vessel is struck but does not bleed, the Qi of the Kidney channel and the Chong Mai will gather near the Rangu point, causing swelling.

If the large pulse in the hollow behind the knee is struck, the person will collapse and their complexion will become abnormal.

Consult the account of the Weizhong point in the Zhonggao Liuzhu Jing, and the ailments attributed here to “Xizhong” will become clear. “Xizhong” is named after the channel point, while “Weizhong” is named after its location. Both refer to the same place, just as “Cunkou,” “Maikou,” and “Qikou” are different names for the same location.

A large vessel runs through Xizhong and belongs to the Foot Taiyang channel. The Foot Taiyang channel begins at the inner corner of the eye, where it meets the Hand Taiyang channel. The Hand Taiyang channel runs obliquely from the inner corner of the eye and connects with the cheekbone. The Foot Taiyang channel ascends to the head, then descends through the neck and continues along the foot. If needling extends beyond the permitted area, a person may suddenly collapse, their face turning ashen, as if drained of blood.

If the vessels at Qijie are needled and no blood comes out, the area may swell into a shape like a crouching mouse.

The vessels of the Gallbladder and Stomach channels run through Qijie. The Gallbladder channel follows the inner side of the ribs and passes through Qijie. The Stomach channel enters Qijie from beside the navel; one of its branches begins at the lower opening of the stomach, runs along the inside of the abdomen, and joins the main channel at Qijie. The ancients believed that if this area was needled without drawing blood, the Qi of the blood vessels would gather locally and form an internal lump resembling a crouching mouse. Qijie lies in the lower abdomen, four cun to either side of the navel. A pulsating vessel can be felt one cun above the pubic region, near the groin. The Revised Collation notes that another edition reads “Shupu” as “Shuxi.” The commentary on the “Qifu Lun” says that Qijie lies at the ends of the transverse bone below the navel, one cun above the groin.

Needling between the vertebrae and striking the marrow can make a person stoop.

“Stoop” means that the body bends forward into a hunch. “Between the vertebrae” here refers to the spaces between the spinal bones. The commentary explains that striking the marrow causes the vital essence within the bones to leak out, making the body bend and hunch.

Needling above the nipple and striking the breast can cause swelling and suppuration, with the root of the abscess eroding the flesh.

The Foot Yangming channel passes above and below the breasts. Milk flows through the breasts, and the Qi and blood of the chest also gather there. If a needle enters the breast, Qi and blood may collect there, causing severe swelling. The lump may suppurate, and the pus can gradually erode the skin and flesh; in time, the wound becomes difficult to heal.

Needling too deeply into Quepen, the hollow above the collarbone, can cause Qi to leak outward, leading to wheezing, coughing, and rebellious Qi.

Among the five Zang organs, the Lung is like an umbrella covering the body. Quepen is a passageway for the breath. The Lung stores Qi and governs respiration, while disturbances in Qi can also manifest as coughing. If the needle goes too deep at Quepen, Lung Qi leaks outward, bringing on wheezing, coughing, and rebellious Qi.

Needling too deeply into the hand’s “fish belly,” the raised area at the base of the thumb, can also cause swelling.

The hand’s “fish belly” is where the vessel Qi of the Lung channel flows. If the needle goes too deep and causes the tissue to sink inward, swelling will occur.

The new textual collation notes that, according to the Jiayi Jing, the word “flow” in “where the Lung pulse flows” should read “remain.”

Do not use acupuncture when someone is extremely drunk. After drinking, the pulse races and the movement of Qi and blood becomes disordered; acupuncture will throw it further into disarray. The new textual collation notes that, according to the Lingshu Jing, “Qi is disordered” should read “the pulse is disordered.”

Do not use acupuncture when someone is extremely angry. Anger makes Qi flow upward in reverse, and acupuncture at such a time will worsen this reversal.

Do not use acupuncture when someone is utterly exhausted, because the Qi in the channels is already moving excessively.

Do not use acupuncture just after someone has eaten to fullness, because Qi and blood are abundant and the abdomen is full.

Do not use acupuncture when someone is extremely hungry, because Qi and blood are deficient.

Do not use acupuncture when someone is extremely thirsty, because the blood vessels are depleted.

Do not use acupuncture when someone has been greatly frightened, because the spirit of the heart is unsettled and the movement of Qi and blood cannot stabilize. The new textual collation notes that, on close examination, these seven prohibitions—from extreme drunkenness to extreme fright—differ slightly from the account in the Lingshu Jing. The Lingshu Jing also says not to use acupuncture just after sexual intercourse, and not to have sexual intercourse after receiving acupuncture. Acupuncture should likewise be avoided when someone is extremely angry, exhausted, drunk, full, hungry, or thirsty; after receiving acupuncture, one should avoid entering any of these states. When someone has been greatly terrified, first settle their breathing and Qi, and only then perform acupuncture.

If a large blood vessel on the inner thigh is needled and the bleeding does not stop, the person will die. The Spleen channel passes through this area of the inner thigh. The Spleen belongs to Earth at the center and is an organ that governs its own domain, distributing Qi and blood throughout the body. If bleeding here does not stop, Spleen Qi will be exhausted, putting the person’s life at risk. The new textual collation notes that Huangfu Shian moved this prohibition to follow the earlier one about needling a large blood vessel on the top of the foot. The entries from this point onward were originally interspersed among the earlier entries.

If “Guest Master” (a point name, now called Shangguan, located above and in front of the ear at the edge of the bone; a hollow appears there when the mouth is opened) is needled too deeply and the vessels within the point are pierced, fluid will seep from the ear and deafness will result. The Hand Shaoyang, Foot Shaoyang, and Foot Yangming channels converge here. The commentary explains that “the vessel in the hollow” refers to needling too deeply; deep needling can injure the converging vessels. Once damaged, they cannot properly nourish the ear with Qi and blood, which may lead to deafness. The new textual collation notes that both the Jiayi Jing and the commentary on the “Qifu Treatise” identify this as the meeting place of the Hand Shaoyang, Foot Shaoyang, and Foot Yangming channels; the original text may have omitted “Foot Shaoyang.”

If needling at the kneecap causes injury and fluid to leak out, the person will become lame.

The knee is where the sinews gather, and the channels of the sinews converge there. Fluids flow out from it, leaving the sinews dry and without nourishment; this is why lameness occurs. (“Bin” is pronounced like “pin.”)

Piercing the Hand Greater Yin channel (the Lung channel) and causing heavy bleeding leads to immediate death. The Hand Greater Yin channel is the Lung vessel. The Lung governs the circulation of nutritive Qi and defensive Qi and harmonizes Yin and Yang. If too much blood is lost, the nutritive and defensive Qi are cut off, and death follows at once.

Injuring the Foot Lesser Yin channel (the Kidney channel) makes an already weakened body more depleted. If bleeding occurs, the tongue becomes difficult to move and speaking becomes difficult. The Foot Lesser Yin Kidney channel runs through the Kidneys, connects with the Lungs, and is linked to the root of the tongue. When Qi and blood are further depleted, the tongue can no longer form words easily.

Piercing the Lung vessel at the hollow in the front of the chest causes panting and rebellious Qi, so that the person can breathe only with the head raised. This happens because Lung Qi surges upward and leaks outward.

If the needle is inserted too deeply and injures the vessels inside the elbow, pathogenic Qi gathers there, making the arm unable to bend or straighten. “Inside the elbow” refers to the Chize point at the bend of the elbow. Inserting the needle too deeply damages the vessels, allowing pathogenic Qi to stagnate and impairing movement of the joint.

Piercing about three inches below the inner thigh and injuring the deeper vessels causes involuntary urination. The Kidney network vessels are found here. The Chong vessel and the network vessels of the Foot Lesser Yin Kidney channel both arise below the Kidneys, pass through Qijie, and ascend along the inner thigh, reaching the Baozhong above—the area containing the bladder and reproductive organs. Injury to the deeper vessels can therefore cause involuntary urination.

Injuring the deep vessels between the ribs below the armpit causes coughing. The Lung vessel passes through the armpit, and the Heart vessel also ascends from the Heart network to the armpit. If the needle is inserted too deeply, it disturbs the Qi of the Heart and Lungs, causing a cough.

Piercing the midline of the lower abdomen, where the bladder is located, causes urine to leak out and the lower abdomen to become distended. Qi from the Baozhong leaks outward, while the Qi of food and drink gathers there, causing distension. “Lower abdomen” here means the area below the navel.

Injuring the deep part of the calf causes swelling. The Foot Greater Yang channel runs through the calf; when the Qi of the Greater Yang channel leaks outward, swelling results.

Injuring the vessels within the bone above the eye socket causes tearing and blindness. “Kuang” means the eye socket; “within the bone” refers to the inside of the socket bone. The vessels in the eye socket connect with the ocular system and are also linked to the Liver channel. If the needle goes too deep and injures the ocular system, the eye will water and may even become blind.

If a joint is injured and its fluids flow out, the person will be unable to bend or straighten it. The sinews attach to the joints, and fluids moisten the sinew membranes. Once the fluids are lost, the membranes become dry and the joint can no longer bend or straighten.